Provider Demographics
NPI:1972504934
Name:CLANCY, NAOMI RINAH (MD)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:RINAH
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:AZ
Mailing Address - Zip Code:85540
Mailing Address - Country:US
Mailing Address - Phone:928-865-9184
Mailing Address - Fax:928-865-7571
Practice Address - Street 1:401 BURRO ALLEY
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:AZ
Practice Address - Zip Code:85540
Practice Address - Country:US
Practice Address - Phone:928-865-9184
Practice Address - Fax:928-865-7571
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004016207Q00000X
AZ48644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM86588711Medicaid
I28080Medicare UPIN
I28080Medicare UPIN